Introduction
Interventional Neuroradiology (Endovascular Neurointerventions/Interventional Neurosurgery) is an advanced surgical and internationally acclaimed super-specialty in which minimally invasive diagnostic and therapeutic procedures for cerebrovascular, head and neck, and spinal disorders are performed under imaging guidance. It is somewhat similar to the treatment carried out in the heart by cardiologists, such as angioplasty or stent placement. In these procedures, very thin sophisticated and advanced catheters / wires are placed through blood vessels in hand or groin and are navigated in the blood vessels to the site of the abnormal vessels. This is followed by diagnostic or therapeutic procedures.
Instead of open surgery, these procedures are done in minimally-invasive techniques which minimizes blood loss. These procedures are now performed at most advanced centers internationally and are well-known to shorten hospital stay and patient recovery times. Neurointerventionists play a crucial role in the diagnosis and management of brain aneurysms, stenosis of arteries such as carotid arteries, arteriovenous malformations, acute ischaemic stroke,etc.
Acute stroke patients can be treated even after delayed hospital presentation in selected cases.
Our Neurosciences team comprising of dedicated experts has extensive experience in providing endovascular treatment and embolization for intracranial aneurysms and arteriovenous malformations (AVM). In addition, we manage and treat acute and chronic stroke, carotid artery and intracranial stenoses, aneurysmal subarachnoid hemorrhages (SAH), cavernomas, developmental venous abnormalities (DVA), moyamoya disease, superficial vascular malformations, spinal vascular malformations, to list a few.
Short hospital stays with reduced recovery times and decreased procedural risks in comparison to open surgery are among the benefits of endovascular neuroradiology and minimally invasive neurointerventional techniques.
Neurointerventional lab- Latest Flat Panel DSA (digital subtraction angiography) with 3-D technology (under procurement) - provides high-resolution angiogram images of cranial and spinal vessels.
3-D technology allows construction of images in 3-D format. This helps in precise assessment of diseases affecting blood vessels such as stenosis, aneurysms and vascular malformations and tracking of catheters and wires to disease site. Additional advantage of cross sectional on-table CT scan reconstructions avoids un-necessary patient shifting and mobilization. In-suite round the clock anaesthesia backup and monitoring is available in case of need.
Availability of elegant and refined neurointerventional material such as coils, microcatheters, balloons, stents, drugs and clot retrieval devices in the DSA laboratory for use at any point of time. SGRH Neurointervention lab was the first centre in Northern India to have the clot aspiration device for vessel recanalization in acute stroke.
Disease | What is it? | What we do? |
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Acute Stroke |
Acute ischemic stroke is sudden onset of focal neurological deficit that occurs from occlusion or ischemia in the territory supplied by cerebral artery. |
Thrombectomy/ Thrombolysis |
Intracranial Aneurysm |
An aneurysm is a balloon-like swelling that results from a weakness in the wall of blood vessels supplying blood to the brain. |
Coiling involves approaching the aneurysm from inside the blood vessel, avoiding the need to open the skull. |
Arteriovenous Malformation (AVM) |
AVMs are abnormal bunch of vessels which form from abnormal communication between vessels supplying (arteries) and taking away blood (veins) leading to flow disturbance in tissues. |
Embolization treatment of AVM is also known as Embolotherapy or Endovascular therapy. It can be curative (with total cure in single or multiple sessions), palliative (to improve symptoms), Pre-operative or pre-radiosurgery, or targeted (to deal high flow component or rupture point) |
Tumor Embolization |
Tumors that are hypervascular have dominant arterial supply. Closing the arteries supplying the tumor and reduction of tumor blush is the ultimate risk management strategy to reduce operative blood loss. |
Tumor embolization is a procedure that can be performed preoperative/palliative to a planned surgical resection. Embolization shuts down the blood supply to a tumor reducing blood loss during surgical resection. A secondary benefit from embolization can be that tumor margins are more easily identified and a tumor can be removed more completely and with less effort. Tumors of the spine, head, and neck that can be embolized have relatively large blood vessels supplying the tumor. |
Carotid Artery Stenting (CAS) and Vertebral Artery Stenting |
What is carotid stenosis and why does it happen? |
Carotid stenting is a day care procedure without need of general anesthesia. Patient is conscious at time of the procedure. CAS is also the preferred therapy for patients who are at an increased risk with carotid surgery. High risk factors include medical comorbidities (severe heart disease, heart failure, severe lung disease, age > 75/80, etc.) and anatomic features (contralateral carotid occlusion, radiation therapy to the neck, prior ipsilateral carotid artery surgery, intra-thoracic or intracranial carotid disease) that make surgery difficult or risky. |
Cerebral DSA/ “Angiography” |
Cerebral Angiography can help diagnose and plan treatment for -
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Cerebral angiography is a diagnostic test that can help evaluate the intracranial and neck cerebral and venous vasculature. |
Spinal AVM Diagnosis and Embolization |
What is spinal AVM? |
Endovascular procedure for spinal AVM is done for the diagnosis and management of the AVM. Fine catheters are used to access the small intercostal branches arising from aorta. Through them, the artery feeding the spinal AVM is accessed and embolic material is injected. |
Intracranial Stenting |
What is ICAD? |
Endovascular treatments (Balloon angioplasty / stenting) is a minimally invasive endovascular procedure that include balloon angioplasty of the stenotic artery, with or without placement of an endoluminal stent. Options of placing a Drug Eluting Stent or using a Drug eluting Balloon which may deposit an antithrombotic drug at the plaque site and may not require the need of placing a stent. |
Venous Thrombolysis and Venous Stenting Procedures |
Cerebral venous sinus thrombosis (CVST) is an increasingly diagnosed disease with a wide range of symptoms, ranging from a mild headache to cerebral herniation. A potentially devastating syndrome, CVST has been associated with a mortality rate of 6-10%. In prospective studies, the overall rate of death and dependency from CVST ranges from 8.8 to 44.4%. Systemic anticoagulation remains the first-line treatment. However, a percentage of patients deteriorate despite medical therapy. These cases have resulted in the development of thrombolysis or endovascular treatment for CVST. The use of endovascular treatment of CVST have been promising. |
Venous endovascular procedures are often life saving. By performed thrombolysis and thrombectomy for clots in the cerebral veins, the venous obstruction is opened up and there is resultant decrease in the cerebral congestion. |
Intra-arterial Chemotherapy |
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Intraarterial chemotherapy is a physiological appealing procedure as the drug gets evenly distributed throughout the tumour capillary vessels and brain parenchyma. Intraarterial treatment of glioblastoma has been attempted since 1950s but the success rate has been quite discouraging. Despite past failures, clinical interest in IA drugs for the treatment of GBM persists. There are several clinical trials with IA GBM treatments with the US national registry. Direct injection of the chemotherapeutic drugs in the tumour feeder vessels makes high concentration of the chemotherapy drugs reaching the tumour bed, could be making them more effective logically. |